3-Step Model- An Explorative Novel Approach To Classify Sepsis: A Longitudinal Observational Study

IntroductionSepsis remains a critical healthcare challenge worldwide, demanding prompt identification and treatment to improve patient outcomes. Given the absence of a definitive gold standard diagnostic test, there is an imperative need for adjunct diagnostic tools to aid in early sepsis detection and guide effective treatment strategies. This study introduces a novel 3-step model to identify and classify sepsis, integrating current knowledge and clinical guidelines to enhance diagnostic precision. MethodsThis longitudinal observational study was conducted at a tertiary care teaching hospital in northern India. Adult patients admitted with suspected sepsis underwent screening using predefined criteria. The 3-step model consisted of Step 1, assessing dysregulated host response using a National Early Warning Score-2 (NEWS-2) score of [≥]6; Step 2, evaluating risk factors for infection; and Step 3, confirming infection presence through clinical, supportive, or confirmatory evidence. Patients were categorized into Asepsis, Possible sepsis, Probable sepsis, or Confirmed sepsis at various intervals during hospitalization. ResultsA total of 230 patients were included. Initial categorization on Day 1 showed 13.0% in Asepsis, 35.2% in Possible sepsis, 51.3% in Probable sepsis, and 0.4% in confirmed sepsis. By Day 7, shifts were observed with 49.7% in Asepsis, 9.5% in Possible sepsis, 25.4% in Probable sepsis, and 15.4% in confirmed sepsis. At discharge or death, categories were 60.4% Asepsis, 5.2% Possible sepsis, 21.7% Probable sepsis, and 12.6% Confirmed sepsis. Transitions between categories were noted throughout hospitalisation, demonstrating the dynamic nature of sepsis progression and response to treatment. ConclusionThe 3-step model effectively stratifies sepsis status over hospitalization, facilitating early identification and classification of septic patients. This approach holds promise for enhancing diagnostic accuracy, guiding clinical decision-making, and optimizing antibiotic stewardship practices. Further validation across diverse patient cohorts and healthcare settings is essential to confirm its utility and generalizability.